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Cognitive Behavioral Therapy for Depression, Anxiety, and Stress in Caregivers of Dementia Patients: A Systematic Review and Meta-Analysis
Open accessAbstract
BACKGROUND AND OBJECTIVES: There is limited evidence for the efficacy of cognitive behavioral therapy (CBT) in managing psychological morbidities in caregivers of dementia patients. To evaluate changes in dementia caregivers' depression, anxiety, and stress following CBT. Also to assess quality of life, intervention adherence/satisfaction and therapy effectiveness using different formats, frequencies, and delivery methods. RESEARCH DESIGN AND METHODS: Studies were identified through electronic bibliographic searches (MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library) and from gray literature (Conference Proceedings Citation Index and clinicaltrials.gov). Data were pooled for meta-analysis. RESULTS: Twenty-five studies were included. Depression (standardized mean difference [SMD] = -0.34; 95% confidence interval [CI] -0.47 to -0.21; p < .001) and stress (SMD = -0.36; 95% CI: -0.52 to -0.20; p < .001) were significantly reduced after CBT, relative to comparator groups, while anxiety was not (SMD = 0.10; 95% CI: -0.18 to 0.39; p = .47). A subgroup analysis demonstrated that statistically significant reductions in depression and stress were limited to group, but not individual, formats. An additional subgroup analysis revealed that eight CBT sessions or fewer were equally effective as more than eight sessions at significantly reducing depression and stress, relative to comparator groups. Furthermore, analysis with independent samples t-tests demonstrated no statistically significant differences between mean changes in depression (MD = 0.79; 95% CI: -0.45 to 2.03; p = .21) and stress (MD = 0.21; 95% CI: -1.43 to 1.85; p = .80) when directly comparing CBT groups of ≤8 and >8 sessions. DISCUSSION AND IMPLICATIONS: Group CBT provides small but significant benefits to caregivers' depression and stress. Therapy cost-effectiveness may be improved by limiting therapy to group formats and eight sessions.
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“A previous meta-analysis of in-person CBT for dementia family carers delivered face-to-face or via telephone demonstrated a small overall effect of CBT on depression (Cohen's effect measure, d = 0.34), while no significant overall effect was observed for anxiety [6].”
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“Meta-analyses reveal that CBT reduces ADRD caregiver depressive symptoms; however, it is less effective for ADRD caregiver anxiety [17, 19, 20].”
From Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer’s disease and related dementias (2021) · cites this paper as [20]
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“A recent meta-analysis of in-person or telephone CBT for family carers of people with dementia delivered by trained professionals demonstrated a small overall effect of CBT on depression (d = 0.34)”
From Internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a feasibility study. (2022) · cites this paper as Hopkinson et al., 2019
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“while no significant overall effect was observed for anxiety”
From Internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a feasibility study. (2022) · cites this paper as Hopkinson et al., 2019
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Cognitive Behavioral Therapy for Menopause Symptoms
Wilkins, V. M. (2025) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-025-00452-y · Cited by 1
“CBT has been useful in managing caregiving stress and could be applied to women during the menopause transition to help cope with caregiving burden [81, 82].”
Alçay, A., & Çutuk, Z. A. (2026) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-026-00656-y · Cited by 1
“In individuals struggling with addic - tion (Alamdarloo et al., 2019 ) and caregivers of dementia patients (Hopkinson et al., 2019 ; Yorulmaz & Dirik, 2021 ), CBT was found to reduce emotional distress significantly.”
Kishita, N., Gould, R. L., Khondoker, M. R., McCracken, L. M., Riggey, M., Trucco, A. P., Howe, D., Couchman, A., Flanagan, E. C., Vishwakarma, R. K., et al. (2026) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2026.101766 · Cited by 1
“6,7 The multidomain effects observed in this trial are therefore particularly important, given the high prevalence of comorbid anxiety and depression, 36 and the increased risk of suicide associated with such comorbidity among family carers of people living with dementia.”
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0027 · Cited by 1
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0008 · Cited by 2
Public Health and Human Flourishing
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0032 · Cited by 1
Understanding the Religion–Physical Health Relationship
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0031 · Cited by 1
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0017 · Cited by 1
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0006 · Cited by 1
Yorulmaz, E., & Di̇ri̇k, G. (2023) · Türk Psikoloji Dergisi · doi:10.31828/turkpsikoloji.1349743 · Cited by 1
Verreault, P., Ouellet, M., Mavounza, C., Laforce, R. J., Vézina, J., & Hudon, C. (2024) · PEC Innovation · doi:10.1016/j.pecinn.2024.100317 · Cited by 1
“The intervention was based on cognitive-behavioral principles, which have shown significant benefits on outcomes such as subjective burden and depressive symptoms in caregivers of individuals living with AD [10,11].”
MethodPsychotherapeutic Support for Family Caregivers of People With Dementia
Singh, M. (2024) · Family Medicine · doi:10.22454/fammed.2024.163089 · Cited by 1
Granier, K. L., & Ingram, R. (2024) · Clinical Gerontologist · doi:10.1080/07317115.2024.2418834 · Cited by 1
“A meta-analysis conducted by Hopkinson et al., (2019) suggests that brief group-based CBT interventions may be optimal for reducing depression and stress among most caregivers, compared to individual sessions and/ or longer groups.”
Stapley, S., Pentecost, C., Quinn, C., Victor, C. R., Thom, J. M., Henderson, C., Rippon, I., Sabatini, S., & Clare, L. (2025) · Ageing and Society · doi:10.1017/s0144686x25000030 · Cited by 2
“…well-being in family members caring for people with dementia (Gilhooly et al., 2016; Rippon et al., 2020), with higher rates of psychological sequelae than among family members caring for those with other chronic conditions (Schoenmakers, Buntinx and Delepeleire, 2010; Hopkinson et al., 2018).”
Talking therapies for anxiety and depression in people affected by dementia: A scoping meta‐review
Charlesworth, G. M., Eastham, C., & Morris, L. (2025) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.70003 · Cited by 1
Treatment of depression in Alzheimer’s disease
Moustafa, A. A., Bilson, L., & Jaroudi, W. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-821334-6.00012-0 · Cited by 1
Life span-related mental health disorders and cognitive behavioral therapy
Rajendram, R., Patel, V. B., & Preedy, V. R. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85757-4.00003-1 · Cited by 1
Interventions for Caregivers of Older Adults
Pinquart, M. (2019) · Springer eBooks · doi:10.1007/978-3-319-69892-2_7-1 · Cited by 1
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.002.0003 · Cited by 1
Fischer, A., Risch, A. K., & Wilz, G. (2020) · Psychotherapie im Alter · doi:10.30820/1613-2637-2020-2-165
Alami, S., Bakhtiarpour, S., Asgari, P., & Khorami, N. S. (2020) · International journal of body, mind and culture · doi:10.22122/ijbmc.v7i4.242
Torres, C. E. F. (2021) · Tesis Doctorals en Xarxa (Consorci de Serveis Universitaris de Catalunya) · doi:10.6035/14103.2021.746623
Interventions for Caregivers of Older Adults
Pinquart, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-22009-9_7
Depressive Disorders Among Family Caregivers of People Living with Dementia
Miranda‐Castillo, C., Tapia‐Muñoz, T., Oliveira, D., & Sáez, S. (2022) · Depression and personality · doi:10.1007/978-3-031-13029-8_10
Metadata
- Authors
- Hopkinson, M. D., Reavell, J., Lane, D. A., & Mallikarjun, P.
- Affiliations
- University of Birmingham (GB)
- Sandwell & West Birmingham Hospitals NHS Trust (GB)
- Corresponding author
- Mallikarjun, Pavan
- Venue
- The Gerontologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-24
- Volume
- 59
- Issue
- 4
- Pages
- e343-e362
- ISSN
- 0016-9013 (ISSN-L)
- 1758-5341
- OpenAlex
- W2790970921
- Cited by
- 142
- References
- 49
- Citations by year
- 2026: 8 · 2025: 24 · 2024: 18 · 2023: 48 · 2022: 12 · 2021: 16 · 2020: 11 · 2019: 4 · 2018: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- The Gerontologist (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- University of Birmingham
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Nursing › Research and Theory › Nursing care and research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- cognitive behavioral therapy, dementia caregivers, caregiver depression, caregiver anxiety, caregiver stress, group therapy, quality of life, intervention adherence, cost-effectiveness
- MeSH terms
- Anxiety, Dementia, Depression, Humans, Psychotherapy, Brief, Psychotherapy, Group, Quality of Life, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Caregivers, Patient Satisfaction
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